Abstract
Purpose
The purpose of this study was to survey surgeons’ preferences surrounding the management and evaluation of proximal humerus fractures internationally.
Methods
A questionnaire was developed using previous literature and input from practicing orthopaedic surgeon opinion leaders. Between November 13, 2014 and December 31, 2014, the questionnaire was posted on the membership section of three major orthopaedic and shoulder surgery association websites. Survey responses were anonymous.
Results
The survey was completed by 134 unique practicing orthopaedic surgeons. The majority of respondents (72%) practiced in North America while 28% practiced internationally. For displaced two-part fractures, a preference for open reduction and internal fixation (ORIF) with locking plates was identified (75%). No consensus was reached for preferred treatment of three- and four- part fractures: 37% chose ORIF with locking plates, 26% chose hemi-arthroplasty (HA), and 29% chose reverse shoulder arthroplasty (RSA). Preferred treatment types for three- and four-part fractures were marginally significantly different depending on place of practice (North America vs. international, p = 0.058). A significantly larger proportion of surgeons who had completed an upper extremity fellowship (35%) chose RSA for the treatment of three and four-part fractures, compared to those who had not (9%, p = 0.002). No consensus was observed regarding what outcome measure is best to assess function following proximal humerus fractures.
Conclusions
The management of more complex, displaced proximal humerus fractures remains controversial. Additionally, there are conflicting opinions on what outcome measure is best to assess function following the treatment of proximal humerus fractures.
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References
Handoll HH, Brorson S (2015) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 11:CD000434. doi:10.1002/14651858.CD000434.pub4
Clement ND, Duckworth AD, McQueen MM, Court-Brown CM (2014) The outcome of proximal humeral fractures in the elderly: predictors of mortality and function. Bone Joint J 96-B(7):970–977. doi:10.1302/0301-620X.96B7.32894
Zhang AL, Schairer WW, Feeley BT (2014) Hospital readmissions after surgical treatment of proximal humerus fractures: is arthroplasty safer than open reduction internal fixation? Clin Orthopaed Relat Res 472(8):2317–2324
Guy P, Slobogean GP, McCormack RG (2010) Treatment preferences for displaced three- and four-part proximal humerus fractures. J Orthop Trauma 24(4):250–254
Bell JE, Leung BC, Spratt KF, Koval KJ, Weinstein JD, Goodman DC, Tosteson AN (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 93(2):121–131
Maravic M, Briot K, Roux C (2014) Burden of proximal humerus fractures in the French National Hospital Database. Orthop Traumatol 100(8):931–934. doi:10.1016/j.otsr.2014.09.017
Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371
Tepass A, Blumenstock G, Weise K, Rolauffs B, Bahrs C (2013) Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg 22(1):e8–14
Gradl G, Knobe M, Pape HC, Neuhaus PV, Ring D, Guitton T (2015) Decision making in displaced fractures of the proximal humerus: fracture or surgeon based? Int Orthop 39(2):329–334. doi:10.1007/s00264-014-2630-5
Hageman MG, Jayakumar P, King JD, Guitton TG, Doornberg JN, Ring D (2015) The factors influencing the decision making of operative treatment for proximal humeral fractures. J Shoulder Elbow Surg 24(1):e21–e26. doi:10.1016/j.jse.2014.05.013
Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, Goodchild L, Chuang LH, Hewitt C, Torgerson D (2015) Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus the PROFHER randomized clinical trial. JAMA 313(10):1037–1047
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elb Surg 20(7):1025–1033
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elb Surg 20(5):747–755
Fjalestad T, Hole MO, Hovden IA, Blucher J, Stromsoe K (2012) Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Orthop Trauma 26(2):98–106
Hodgson SA, Mawson SJ, Saxton JM, Stanley D (2007) Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). J Shoulder Elb Surg 16(2):143–145
Agorastides I, Sinopidis C, El Meligy M, Yin Q, Brownson P, Frostick SP (2007) Early versus late mobilization after hemiarthroplasty for proximal humeral fractures. J Shoulder Elb Surg 16(3 SUPPL):S33–S38
Sukthankar AV, Leonello DT, Hertel RW, Ding GS, Sandow MJ (2013) A comprehensive classification of proximal humeral fractures: HGLS system. J Shoulder Elb Surg 22(7):e1–e6
Ramappa AJ, Patel V, Goswami K, Zurakowski D, Yablon C, Rodriguez EK, Appleton P, DeAngelis JP (2014) Using computed tomography to assess proximal humerus fractures. Am J Orthop 43(3):E43–E47
Foroohar A, Tosti R, Richmond JM, Gaughan JP, Ilyas AM (2011) Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience. J Orthop Surg Res 6:38
Brorson S, Eckardt H, Audige L, Rolauffs B, Bahrs C (2013) Translation between the Neer- and the AO/OTA-classification for proximal humeral fractures: do we need to be bilingual to interpret the scientific literature? BMC Res Notes 6:69
Neuhaus V, Swellengrebel CH, Bossen JK, Ring D (2013) What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture? Clin Orthop Relat Res 471(5):1698–1706. doi:10.1007/s11999-013-2876-z
Ministry of Health and Long Term Care (2015) Schedule of Benefits - Physician Services Under the Health Insurance Act. Ministry of Health and Long Term Care, Ontario, Canada
Sebastia-Forcada E, Cebrian-Gomez R, Lizaur-Utrilla A, Gil-Guillen V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23 (10):1419-1426
van de Water AT, Shields N, Taylor NF (2011) Outcome measures in the management of proximal humeral fractures: a systematic review of their use and psychometric properties. J Shoulder Elbow Surg 20 (2):333-343. doi:http://dx.Doi.Org/10.1016/j.Jse.2010.10.028
Slobogean GP, Noonan VK, O’Brien PJ (2010) The reliability and validity of the disabilities of arm, shoulder, and hand, EuroQol-5D, health utilities index, and short form-6D outcome instruments in patients with proximal humeral fractures. J Shoulder Elbow Surg 19(3):342–348
van de Water AT, Shields N, Davidson M, Evans M, Taylor NF (2014) Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture. Disabil Rehabil 36(13):1072–1079
Siebenbürger G, Van Delden D, Helfen T, Haasters F, Böcker W, Ockert B (2015) Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures. Injury 46(supplement 4):S58–S62. doi:10.1016/S0020-1383(15)30019-X
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Nowak, L.L., Vicente, M.R., McKee, M.D. et al. Orthopaedic surgeons’ opinions surrounding the management of proximal humerus fractures: an international survey. International Orthopaedics (SICOT) 41, 1749–1755 (2017). https://doi.org/10.1007/s00264-017-3569-0
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DOI: https://doi.org/10.1007/s00264-017-3569-0